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Urology

Kidney Cancer

Kidney cancer (Renal Cell Carcinoma) is a disease that can progress insidiously but has a very high treatment success rate when diagnosed early. Urothelial carcinomas, on the other hand, are a different type of cancer that develops from the urine-collecting ducts of the kidney.

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ℹWhat is Kidney Cancer?

Renal Cell Carcinoma (RCC):

This is the formation of a tumor due to the uncontrolled proliferation of cells in the kidney. The most common type is Clear Cell (70-80%), followed by Papillary and Chromophobe RCC.

Urothelial Carcinoma:

A type of cancer originating from the transitional epithelial cells lining the urine-collecting ducts and the ureter inside the kidney. Since these same cells also line the bladder, there is a 20% risk of similar tumors occurring in the bladder as well.

Common Symptoms

Blood in Urine (Hematuria)
The most common symptom. It can be macroscopic or microscopic.
Flank Pain
Persistent dull pain in the flank or lower back due to mass effect.
Palpable Mass
A firm swelling palpable in the abdomen or flank.
Systemic Symptoms
Unexplained weight loss, fatigue, anorexia, unexplained fever, hypertension, and hypercalcemia.
Urothelial Carcinoma Symptoms
Painless hematuria, obstructive kidney pain (renal colic), and difficulty urinating.

Diagnosis Methods

Ultrasonography
Most commonly used radiation-free method for initial assessment.
CT (Renal Angio CT)
Provides information about the size of the tumor, its relationship with the renal vessels, and lung metastasis.
MRI (Renal Angio MRI)
Clearly shows vascular anatomy, involvement of the tumor in the renal vein/vena cava, and spread into surrounding tissues.
CT/MRI Urography (Urothelial)
Imaging taken with a special dye that colors the urinary tracts; the most important method in the diagnosis of urothelial carcinoma.
Ureterorenoscopy and Biopsy
Entering the urinary tract with camera-equipped instruments to visualize the tumor and take a biopsy.

Causes

Smoking
The most important modifiable risk factor.
Obesity
Increases risk through hormonal changes.
Hypertension
High blood pressure may cause damage to renal cells.
Genetic Factors
Hereditary conditions such as Von Hippel-Lindau (VHL) syndrome.
Chronic Kidney Failure
Risk is elevated in long-term dialysis patients.

Treatments

Robotic Partial Nephrectomy
Removal of only the tumor while preserving the kidney. Reduces the risk of kidney failure and increases quality of life.
Radical Nephrectomy
If the tumor is very large, removal of the entire kidney along with the surrounding fatty tissue. Can be performed robotically/laparoscopically.
Ablative Therapies
Cryotherapy or radiofrequency ablation for patients unsuitable for surgery.
Targeted Therapy (TKIs)
In metastatic disease: Sunitinib, Pazopanib, Axitinib, Cabozantinib, and Lenvatinib.
Immunotherapy
Checkpoint inhibitors: Nivolumab, Pembrolizumab, Ipilimumab, and Atezolizumab.
Radical Nephroureterectomy (Urothelial)
Removal of the kidney and ureter along with the site where it opens into the bladder. The gold standard treatment.
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